Production of hydroxyapatite layers on the plasma electrolytically oxidized surface of titanium alloys

Micro-arc oxidation (MAO) and its potential for improving the performance of titanium implants in biomedical applications

Titanium (Ti) and its alloys have good biocompatibility, mechanical properties and corrosion resistance, making them attractive for biomedical applications. However, their biological inertness and lack of antimicrobial properties may compromise the success of implants. In this review, the potential of micro-arc oxidation (MAO) technology to create bioactive coatings on Ti implants is discussed. The review covers the following aspects: 1) different factors, such as electrolyte, voltage and current, affect the properties of MAO coatings; 2) MAO coatings affect biocompatibility, including cytocompatibility, hemocompatibility, angiogenic activity, corrosion resistance, osteogenic activity and osseointegration; 3) antibacterial properties can be achieved by adding copper (Cu), silver (Ag), zinc (Zn) and other elements to achieve antimicrobial properties; and 4) MAO can be combined with other physical and chemical techniques to enhance the performance of MAO coatings. It is concluded that MAO coatings offer new opportunities for improving the use of Ti and its alloys in biomedical applications, and some suggestions for future research are provided.

There Are over 60 Ways to Produce Biocompatible Calcium Orthophosphate (CaPO4) Deposits on Various Substrates

A The present overview describes various production techniques for biocompatible calcium orthophosphate (abbreviated as CaPO4) deposits (coatings, films and layers) on the surfaces of various types of substrates to impart the biocompatible properties for artificial bone grafts. Since, after being implanted, the grafts always interact with the surrounding biological tissues at the interfaces, their surface properties are considered critical to clinical success. Due to the limited number of materials that can be tolerated in vivo, a new specialty of surface engineering has been developed to desirably modify any unacceptable material surface characteristics while maintaining the useful bulk performance. In 1975, the development of this approach led to the emergence of a special class of artificial bone grafts, in which various mechanically stable (and thus suitable for load-bearing applications) implantable biomaterials and artificial devices were coated with CaPO4. Since then, more than 7500 papers have been published on this subject and more than 500 new publications are added annually. In this review, a comprehensive analysis of the available literature has been performed with the main goal of finding as many deposition techniques as possible and more than 60 methods (double that if all known modifications are counted) for producing CaPO4 deposits on various substrates have been systematically described. Thus, besides the introduction, general knowledge and terminology, this review consists of two unequal parts. The first (bigger) part is a comprehensive summary of the known CaPO4 deposition techniques both currently used and discontinued/underdeveloped ones with brief descriptions of their major physical and chemical principles coupled with the key process parameters (when possible) to inform readers of their existence and remind them of the unused ones. The second (smaller) part includes fleeting essays on the most important properties and current biomedical applications of the CaPO4 deposits with an indication of possible future developments.

Nitrilotriacetic Acid Improves Plasma Electrolytic Oxidation of Titanium for Biomedical Applications

Dental implants have become a routine, affordable, and highly reliable technology to replace tooth loss. In this regard, titanium and its alloys are the metals of choice for the manufacture of dental implants because they are chemically inert and biocompatible. However, for special cohorts of patients, there is still a need for improvements, specifically to increase the ability of implants to integrate into the bone and gum tissues and to prevent bacterial infections that can subsequently lead to peri-implantitis and implant failures. Therefore, titanium implants require sophisticated approaches to improve their postoperative healing and long-term stability. Such treatments range from sandblasting to calcium phosphate coating, fluoride application, ultraviolet irradiation, and anodization to increase the bioactivity of the surface. Plasma electrolytic oxidation (PEO) has gained popularity as a method for modifying metal surfaces and delivering the desired mechanical and chemical properties. The outcome of PEO treatment depends on the electrochemical parameters and composition of the bath electrolyte. In this study, we investigated how complexing agents affect the PEO surfaces and found that nitrilotriacetic acid (NTA) can be used to develop efficient PEO protocols. The PEO surfaces generated with NTA in combination with sources of calcium and phosphorus were shown to increase the corrosion resistance of the titanium substrate. They also support cell proliferation and reduce bacterial colonization and, hence, lead to a reduction in failed implants and repeated surgeries. Moreover, NTA is an ecologically favorable chelating agent. These features are necessary for the biomedical industry to be able to contribute to the sustainability of the public healthcare system. Therefore, NTA is proposed to be used as a component of the PEO bath electrolyte to obtain bioactive surface layers with properties desired for next-generation dental implants.

Effect of Hydroxyapatite Coating in Combination with Physical Modifications on Microshear Bond Strength of Zirconia to Resin Cement

Background

Zirconia has been used as a reliable core material in dental restorations for years; however, its bonding to resin cement is a matter of challenge. Physical, chemical, and combinations of these techniques have been investigated to boost the properties of zirconia surface bonding. The objective of this work was to evaluate the effect of hydroxyapatite coating as a chemical therapy in combination with physical modifications on the microshear bond strength of the resin cement over zirconia.

Methods

In the present research, 60 sintered zirconia blocks (4 × 4 × 4 mm) were randomized into four groups of 15, including Al₂O₃ particle abrasion (group 1), HA coating (group 2), Al₂O₃ particle abrasion + HA coating (group 3), and Er, Cr: YSGG laser irradiation + HA coating (group 4). The microshear bond strength was determined by bonding the blocks to the resin cement.

Results

The bond strengths (mean ± standard deviation) of modified zirconia surfaces were 16.93 ± 4.94 MPa, 16.14 ± 5.4 MPa, 19.4 ± 5.27 MPa, and 16.21 ± 3.7 MPa in groups 1-4, respectively. Test results of the ANOVA test revealed no significant difference regarding the bond strength values of zirconia surfaces to the resin cement between the studied preparation modalities (p > 0.05).

Conclusion

Observations from the present study showed that HA coating can be as effective as the air-borne particle abrasion technique in improving bond strength to zirconia surfaces. Moreover, sandblasting by an aluminum oxide or Er, Cr: YSGG laser irradiation prior to HA coating of zirconia showed no significant effect on the reinforcement of bond strength values when compared to HA coating alone. The clinic hydroxyapatite coating alone or in combination with physical treatments improves the bond strength of zirconia to resin cement.

Hydroxyapatite Coating on Ti-6Al-7Nb Alloy by Plasma Electrolytic Oxidation in Salt-Based Electrolyte

Titanium alloys have good biocompatibility and good mechanical properties, making them particularly suitable for dental and orthopedic implants. Improving their osseointegration with human bones is one of the most essential tasks. This can be achieved by developing hydroxyapatite (HA) on the treating surface using the plasma electrolytic oxidation (PEO) method in molten salt. In this study, a coating of titanium oxide-containing HA nanoparticles was formed on Ti-6Al-7Nb alloy by PEO in molten salt. Then, samples were subjected to hydrothermal treatment (HTT) to form HA crystals sized 0.5 to 1 μm. The effect of the current and voltage frequency for the creation of the coating on the morphology, chemical, and phase composition was studied. The anti-corrosion properties of the samples were studied using the potentiodynamic polarization test (PPT) and electrochemical impedance spectroscopy (EIS). An assessment of the morphology of the sample formed at a frequency of 100 Hz shows that the structure of this coating has a uniform submicron porosity, and its surface shows high hydrophilicity and anti-corrosion properties (4.90 × 10⁶ Ohm·cm²). In this work, for the first time, the process of formation of a bioactive coating consisting of titanium oxides and HA was studied by the PEO method in molten salts.

The Relationship between Osteoinduction and Vascularization: Comparing the Ectopic Bone Formation of Five Different Calcium Phosphate Biomaterials

Objective: The objective of this study is to compare the bone induction of five kinds of calcium phosphate (Ca-P) biomaterials implanted in mice and explore the vascularization and particle-size-related osteoinductive mechanism. Methods: The following five kinds of Ca-P biomaterials including hydroxyapatite (HA) and/or tricalcium phosphate (TCP) were implanted in the muscle of 30 BALB/c mice (n = 6): 20 nm HA (20HA), 60 nm HA (60HA), 12 µm HA (12HA), 100 nm TCP (100TCP) and 12 µm HA + 100 nm TCP (HATCP). Then, all animals were put on a treadmill to run 30 min at a 6 m/h speed each day. Five and ten weeks later, three mice of each group were killed, and the samples were harvested to assess the osteoinductive effects by hematoxylin eosin (HE), Masson’s trichrome and safranine−fast green stainings, and the immunohistochemistry of the angiogenesis and osteogenesis markers CD31 and type I collagen (ColI). Results: The numbers of blood vessels were 139 ± 29, 118 ± 25, 78 ± 15, 65 ± 14 in groups HATCP, 100TCP, 60HA and 20HA, respectively, which were significantly higher than that of group 12HA (12 ± 5) in week 5 (p < 0.05). The area percentages of new bone tissue were (7.33 ± 1.26)% and (8.49 ± 1.38)% in groups 100TCP and HATCP, respectively, which were significantly higher than those in groups 20HA (3.27 ± 0.38)% and 60HA (3.43 ± 0.27)% (p < 0.05); however, no bone tissue was found in group 12HA 10 weeks after transplantation. The expression of CD31 was positive in new blood vessels, and the expression of ColI was positive in new bone tissue. Conclusions: Nanoscale Ca-P biomaterials could induce osteogenesis in mice muscle, and the osteoinductive effects of TCP were about 124% higher than those of 20HA and 114% higher than those of 60HA. The particle size of the biomaterials affected angiogenesis and osteogenesis. There was a positive correlation between the number of blood vessels and the area percentage of new bone tissue; therefore, osteoinduction is closely related to vascularization. Our results provide an experimental basis for the synthesis of calcium−phosphorus matrix composites and for further exploration of the osteoinductive mechanism.

Evolution of anodised titanium for implant applications

Anodised titanium has a long history as a coating structure for implants due to its bioactive and ossified surface, which promotes rapid bone integration. In response to the growing literature on anodised titanium, this article is the first to revisit the evolution of anodised titanium as an implant coating. The review reports the process and mechanisms for the engineering of distinctive anodised titanium structures, the significant factors influencing the mechanisms of its formation, bioactivity, as well as recent pre- and post-surface treatments proposed to improve the performance of anodised titanium. The review then broadens the discussion to include future functional trends of anodised titanium, ranging from the provision of higher surface energy interactions in the design of biocomposite coatings (template stencil interface for mechanical interlock) to techniques for measuring the bone-to-implant contact (BIC), each with their own challenges. Overall, this paper provides up-to-date information on the impacts of the structure and function of anodised titanium as an implant coating in vitro and in/ex vivo tests, as well as the four key future challenges that are important for its clinical translations, namely (i) techniques to enhance the mechanical stability and (ii) testing techniques to measure the mechanical stability of anodised titanium, (iii) real-time/in-situ detection methods for surface reactions, and (iv) cost-effectiveness for anodised titanium and its safety as a bone implant coating.

Additively manufactured titanium scaffolds and osteointegration - meta-analyses and moderator-analyses of in vivo biomechanical testing

Introduction

Maximizing osteointegration potential of three-dimensionally-printed porous titanium (3DPPT) is an ongoing focus in biomaterial research. Many strategies are proposed and tested but there is no weighted comparison of results.

Methods

We systematically searched Pubmed and Embase to obtain two pools of 3DPPT studies that performed mechanical implant-removal testing in animal models and whose characteristics were sufficiently similar to compare the outcomes in meta-analyses (MAs). We expanded these MAs to multivariable meta-regressions (moderator analysis) to verify whether statistical models including reported scaffold features (e.g., “pore-size”, “porosity”, “type of unit cell”) or post-printing treatments (e.g., surface treatments, adding agents) could explain the observed differences in treatment effects (expressed as shear strength of bone-titanium interface).

Results

“Animal type” (species of animal in which the 3DPPT was implanted) and “type of post-treatment” (treatment performed after 3D printing) were moderators providing statistically significant models for differences in mechanical removal strength. An interaction model with covariables “pore-size” and “porosity” in a rabbit subgroup analysis (the most reported animal model) was also significant. Impact of other moderators (including “time” and “location of implant”) was not statistically significant.

Discussion/conclusion

Our findings suggest a stronger effect from porosity in a rat than in a sheep model. Additionally, adding a calcium-containing layer does not improve removal strength but the other post-treatments do. Our results provide overview and new insights, but little narrowing of existing value ranges. Consequent reporting of 3DPPT characteristics, standardized comparison, and expression of porosity in terms of surface roughness could help tackle these existing dilemmas.

Graphical abstract

Plasma Electrolytic Oxidation (PEO) Process-Processing, Properties, and Applications

Plasma electrolytic oxidation (PEO) is a novel surface treatment process to produce thick, dense metal oxide coatings, especially on light metals, primarily to improve their wear and corrosion resistance. The coating manufactured from the PEO process is relatively superior to normal anodic oxidation. It is widely employed in the fields of mechanical, petrochemical, and biomedical industries, to name a few. Several investigations have been carried out to study the coating performance developed through the PEO process in the past. This review attempts to summarize and explain some of the fundamental aspects of the PEO process, mechanism of coating formation, the processing conditions that impact the process, the main characteristics of the process, the microstructures evolved in the coating, the mechanical and tribological properties of the coating, and the influence of environmental conditions on the coating process. Recently, the PEO process has also been employed to produce nanocomposite coatings by incorporating nanoparticles in the electrolyte. This review also narrates some of the recent developments in the field of nanocomposite coatings with examples and their applications. Additionally, some of the applications of the PEO coatings have been demonstrated. Moreover, the significance of the PEO process, its current trends, and its scope of future work are highlighted.

Additive manufacturing of Ti6Al4V alloy via electron beam melting for the development of implants for the biomedical industry

Additive Manufacturing (AM) or rapid prototyping technologies are presented as one of the best options to produce customized prostheses and implants with high-level requirements in terms of complex geometries, mechanical properties, and short production times. The AM method that has been more investigated to obtain metallic implants for medical and biomedical use is Electron Beam Melting (EBM), which is based on the powder bed fusion technique. One of the most common metals employed to manufacture medical implants is titanium. Although discovered in 1790, titanium and its alloys only started to be used as engineering materials for biomedical prostheses after the 1950s. In the biomedical field, these materials have been mainly employed to facilitate bone adhesion and fixation, as well as for joint replacement surgeries, thanks to their good chemical, mechanical, and biocompatibility properties. Therefore, this study aims to collect relevant and up-to-date information from an exhaustive literature review on EBM and its applications in the medical and biomedical fields. This AM method has become increasingly popular in the manufacturing sector due to its great versatility and geometry control.

Antibacterial Titanium Implants Biofunctionalized by Plasma Electrolytic Oxidation with Silver, Zinc, and Copper: A Systematic Review

Patients receiving orthopedic implants are at risk of implant-associated infections (IAI). A growing number of antibiotic-resistant bacteria threaten to hamper the treatment of IAI. The focus has, therefore, shifted towards the development of implants with intrinsic antibacterial activity to prevent the occurrence of infection. The use of Ag, Cu, and Zn has gained momentum as these elements display strong antibacterial behavior and target a wide spectrum of bacteria. In order to incorporate these elements into the surface of titanium-based bone implants, plasma electrolytic oxidation (PEO) has been widely investigated as a single-step process that can biofunctionalize these (highly porous) implant surfaces. Here, we present a systematic review of the studies published between 2009 until 2020 on the biomaterial properties, antibacterial behavior, and biocompatibility of titanium implants biofunctionalized by PEO using Ag, Cu, and Zn. We observed that 100% of surfaces bearing Ag (Ag-surfaces), 93% of surfaces bearing Cu (Cu-surfaces), 73% of surfaces bearing Zn (Zn-surfaces), and 100% of surfaces combining Ag, Cu, and Zn resulted in a significant (i.e., >50%) reduction of bacterial load, while 13% of Ag-surfaces, 10% of Cu-surfaces, and none of Zn or combined Ag, Cu, and Zn surfaces reported cytotoxicity against osteoblasts, stem cells, and immune cells. A majority of the studies investigated the antibacterial activity against S. aureus. Important areas for future research include the biofunctionalization of additively manufactured porous implants and surfaces combining Ag, Cu, and Zn. Furthermore, the antibacterial activity of such implants should be determined in assays focused on prevention, rather than the treatment of IAIs. These implants should be tested using appropriate in vivo bone infection models capable of assessing whether titanium implants biofunctionalized by PEO with Ag, Cu, and Zn can contribute to protect patients against IAI.

Micro/nanostructured calcium phytate coating on titanium fabricated by chemical conversion deposition for biomedical application

A bioactive micro/nanostructured calcium phytate coating was successfully prepared on titanium surfaces by chemical conversion deposition, mainly through hydrothermal treatment of a mixed solution of phytic acid and saturated calcium hydroxide solution. Ultraviolet radiation was carried out to improve the adhesion of the coating to the titanium substrate. Pure titanium with a sandblasted/acid-etched surface was used as the control group. The topography and chemical composition of the modified surfaces were characterized by scanning electron microscopy (SEM), atomic force microscopy (AFM), X-ray photoelectron spectroscopy (XPS), energy-dispersive X-ray spectroscopy (EDX), and static water contact angle measurement. A pull-off test was performed to measure the coating-to-substrate adhesion strength. Bovine serum albumin was used as a model to study the protein adsorption effect. Cells were cultured on titanium surfaces for 7 days in osteogenic differentiation medium, then the osteoblast compatibility in vitro were explored by alkaline phosphatase and alizarin red staining. After 1, 2, 4 and 8 wks of immediate implantation of titanium implants into the mandibles of New Zealand white rabbits, biological effects in vivo were researched by microcomputed tomography analysis and histological evaluation. The results indicated that the roughness and hydrophilicity of the modified surfaces with micro/nanostructure remarkably increased compared to those of the control group. The pull-off test showed the average adhesion strength at the coating-substrate interface to be higher than 13.56 ± 1.71 MPa. In addition, approximately 4.41 mg/L calcium ion was released from the calcium phytate micro/nano coatings to the local environment after 48 h of immersion. More importantly, the micro/nanostructure titanium substrates significantly promoted cellular differentiation in vitro and in vivo. After 8 wks, the bone implant contact ratio (BIC, %) of the modified implants was higher than that of the control group, at 94.09 ± 0.55% and 86.18 ± 1.99% (p < 0.05). Overall, this study provided new insights into the factors promoting early osseointegration of titanium alloys, which had great potential not only for dental implants but also for various other biomaterial applications.

Analysis of the Calcium Phosphate-Based Hybrid Layer Formed on a Ti-6Al-7Nb Alloy to Enhance the Ossseointegration Process

This paper reports on hybrid, bioactive ceramic Ca-P-based coating formation on a Ti-6Al-7Nb alloy substrate to enhance the osseointegration process. The Ti alloy was anodized in a Ca₃(PO₄)₂ suspension and then the additional layer was formed by the sol-gel technique to obtain a mixture of the calcium phosphate compounds. The oxide layer was porous and additional ceramic particles were formed after sol-gel treatment (scanning electron microscopy analysis coupled with energy-dispersive x-ray spectroscopy). The ceramic particles were formed on some parts of the oxide layer and did not completely fill the pores. The layer thickness of the anodized Ti alloy was comprised between 3.01 and 5.03 µm and increased to 7.52–12.30 µm after the formation of an additional layer. Post-treatment of the anodized Ti alloys caused a decrease in surface roughness, and the layer became strongly hydrophilic. Crystalline phase analysis (X-ray diffraction, XRD) showed that the hybrid layer was composed of TiO₂ (anatase), Ca₃(PO₄)₂, Ca₁₀(PO₄)₆(OH)₂ and a partially amorphous phase; thus, the layer was also analyzed by Raman spectroscopy. The hybrid layer showed worse adhesion to the substrate than the anodized layer only; however, the coating was not brittle, and the first delamination of the layer was determined at 1.84 ± 0.11 N during scratch-test measurement. The hybrid coating was favorable for collagen type I and lactoferrin adsorption, strongly influencing the proliferation of osteoblast-like MG-63 cells. The coatings were cytocompatible and may find applications in formation of the functional layers on long-term implants’ surface after.

Development of tantalum with highly hydrophilic surface and antimicrobial properties obtained by micro-arc oxidation process

Tantalum (Ta) and its application in biomaterials has been attracting more and more attention recently. It can be considered as a material for hard tissue implants. This study focuses on antimicrobial and surface characterization of micro-arc oxidized (MAO) nanocrystalline Ta compared with its microcrystalline equivalent. For the purposes of the investigation, x-ray diffractometry (XRD), scanning electron microscopy (SEM), atomic force microscopy (AFM), wetting analysis, optical profilometry, corrosion resistance measurement, and antimicrobial tests were performed. Nanocrystalline Ta was fabricated using high-energy ball milling (HEBM) and pulse plasma sintering (PPS). The MAO process done at 250 V results in the formation of a porous oxide surface. An XRD analysis confirmed the presence of a Ta₂ O₅ oxide layer. Based on the SEM pictures, the obtained oxide layer was approximately 3-4 μm thick for nanocrystalline Ta substrate. For microcrystalline Ta, the oxide layer was thinner, in the range of 0.3-0.6 μm. The analysis of polarization curves showed a significant improvement of corrosion resistance for MAO nanocrystalline Ta (2.62 × 10^-8 A/cm² ) versus not oxidized nanocrystalline Ta (1.20 × 10^-5 A/cm² ). The surface roughness of MAO nanocrystalline Ta proved to be several times higher than that of unoxidized Ta. Wetting analysis showed that the oxide layer on the nanocrystalline substrate is hydrophilic. This research provides detailed information about MAO microcrystalline and MAO nanocrystalline Ta antimicrobial activity against Staphylococcus aureus and Pseudomonas aeruginosa. A significant decrease of S. aureus for MAO nanocrystalline Ta (control 10,435 ± 981 vs. sample 3,453 ± 130) was noticed. No significant difference was noticed for MAO microcrystalline and nanocrystalline Ta tested for P. aeruginosa.

Effects of the sources of calcium and phosphorus on the structural and functional properties of ceramic coatings on titanium dental implants produced by plasma electrolytic oxidation

Plasma Electrolytic Oxidation (PEO) is as a promising technique to modify metal surfaces by application of oxide ceramic coatings with appropriate physical, chemical and biological characteristics. Therefore, objective of this research was to find the simplest settings, yet able to produce relevant bioactive implant surfaces layers on Ti implants by means of PEO. We show that an electrolyte containing potassium dihydrogen phosphate as a source of P and either calcium hydroxide or calcium formate as a source of Ca in combination with a chelating agent, ethylenediamine tetraacetic acid (EDTA), is suitable for PEO to deliver coatings with desired properties. We determined surface morphology, roughness, wettability, chemical and phase composition of titanium after the PEO process. To investigate biocompatibility and bacterial properties of the PEO oxide coatings we used microbial and cell culture tests. The electrolyte based on Ca(OH)₂ and EDTA promotes active crystallization of apatites after PEO processing of the Ti implants. The PEO layers can increase electrochemical corrosion resistance. The PEO can be potentially used for development of bioactive surfaces with increased support of eukaryotic cells while inhibiting attachment and growth of bacteria without use of antibacterial agents.

Zn- or Cu-Containing CaP-Based Coatings Formed by Micro-arc Oxidation on Titanium and Ti-40Nb Alloy: Part I-Microstructure, Composition and Properties

Zn- and Cu-containing CaP-based coatings, obtained by micro-arc oxidation process, were deposited on substrates made of pure titanium (Ti) and novel Ti-40Nb alloy. The microstructure, phase, and elemental composition, as well as physicochemical and mechanical properties, were examined for unmodified CaP and Zn- or Cu-containing CaP coatings, in relation to the applied voltage that was varied in the range from 200 to 350 V. The unmodified CaP coatings on both types of substrates had mainly an amorphous microstructure with a minimal content of the CaHPO₄ phase for all applied voltages. The CaP coatings modified with Zn or Cu had a range from amorphous to nano- and microcrystalline structure that contained micro-sized CaHPO₄ and Ca(H₂PO₄)₂·H₂O phases, as well as nano-sized β-Ca₂P₂O₇, CaHPO₄, TiO₂, and Nb₂O₅ phases. The crystallinity of the formed coatings increased in the following order: CaP/TiNb < Zn-CaP/TiNb < Cu-CaP/TiNb < CaP/Ti < Zn-CaP/Ti < Cu-CaP/Ti. The increase in the applied voltage led to a linear increase in thickness, roughness, and porosity of all types of coatings, unlike adhesive strength that was inversely proportional to an increase in the applied voltage. The increase in the applied voltage did not affect the Zn or Cu concentration (~0.4 at%), but led to an increase in the Ca/P atomic ratio from 0.3 to 0.7.

A Review of In-Situ Grown Nanocomposite Coatings for Titanium Alloy Implants

Composite coatings are commonly applied to medical metal implants in order to improve biocompatibility and/or bioactivity. In this context, two types of titanium-based composite coatings have been reviewed as biocompatible and anti-bacterial coatings. The different composites can be synthesised on the surface of titanium using various methods, which have their own advantages and disadvantages. Moving with the smart and nanotechnology, multifunctional nanocomposite coatings have been introduced on implants and scaffolds for tissue engineering with the aim of providing more than one properties when required. In this context, titanium dioxide (TiO2) nanotubes have been shown to enhance the properties of titanium-based implants as part of nanocomposite coatings.

Mesoporous Hydroxyapatite Nanoparticles Mediate the Release and Bioactivity of BMP-2 for Enhanced Bone Regeneration

Efficient delivery of bone morphogenetic protein-2 (BMP-2) with desirable bioactivity is still a great challenge in the field of bone regeneration. In this study, a silk fibroin/chitosan scaffold incorporated with BMP-2-loaded mesoporous hydroxyapatite nanoparticles (mHANPs) was prepared (SCH-L). BMP-2 was preloaded onto mHANPs with a high surface area before mixing with a silk fibroin/chitosan composite. Bare (without BMP-2) silk fibroin/chitosan/mHANP (SCH) scaffolds and SCH scaffolds with directly absorbed BMP-2 (SCH-D) were investigated in parallel for comparison. In vitro release kinetics indicated that BMP-2 released from the SCH-L scaffold showed a significantly lower initial burst release, followed by a more sustained release over time than the SCH-D scaffold. In vitro cell viability, osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs), and the in vivo osteogenic effect of scaffolds in a rat calvarial defect were evaluated. The results showed that compared with bare SCH and SCH-D scaffolds, the SCH-L scaffold significantly promoted the osteogenic differentiation of BMSCs in vitro and induced more pronounced bone formation in vivo. Further studies demonstrated that the mHANP-mediated satisfactory conformational change and sustained release benefited the protection of the released BMP-2 bioactivity, as confirmed by alkaline phosphatase (ALP) activity and a mineralization deposition assay. More importantly, the interaction of BMP-2/mHANPs enhanced the binding ability of BMP-2 to cellular receptors, thereby maintaining its biological activity in osteogenic differentiation and osteoinductivity well, which contributed to the markedly promoted in vitro and in vivo osteogenic efficacy of the SCH-L scaffold. Taken together, these results provide strong evidence that mHANPs represent an attractive carrier for binding BMP-2 to scaffolds. The SCH-L scaffold shows promising potential for bone tissue regeneration applications.

Exploiting Direct Current Plasma Electrolytic Oxidation to Boost Photoelectrocatalysis

In this study, we report an investigation of the photoelectrochemical activity of TiO2 films formed by DC plasma electrolytic oxidation (PEO) at a variable potential in a sulfuric acid electrolyte at 0 and 25 °C. The surface morphology was mainly determined by the oxide-forming potential. X-Ray Diffraction and Raman analyses showed that the relative amount of the anatase and rutile phases varied from 100% anatase at low potential (110–130 V) to 100% rutile at high potential (180–200 V), while mixed-phase oxide films formed at intermediate potential. Correspondingly, the band gap of the TiO2 films decreased from about 3.20 eV (pure anatase) to 2.94 eV (pure rutile) and was red-shifted about 0.1 eV by reducing the electrolyte temperature from 25 °C to 0 °C. Glow-Discharge Optical Emission Spectroscopy (GD-OES) and X-ray Photoelectron Spectroscopy (XPS) analyses evidenced S-containing species located preferentially close to the TiO2/Ti interface. The photoelectrochemical activity was assessed by measuring the incident photon-to-current efficiency (IPCE) under Ultraviolet C (UV-C) irradiation, which showed a non-gaussian normal trend as a function of the PEO cell potential, with maximum values exceeding 80%. Photoelectrocatalytic activity was assessed by decolorization of model solutions containing methylene blue. Photoanodes having higher IPCE values showed faster decolorization kinetics.

Enhanced osteogenic differentiation of BMSCs and M2-phenotype polarization of macrophages on a titanium surface modified with graphene oxide for potential implant applications

Osseointegration at the bone–implant interface is a complex biological process that is triggered by the immune-inflammatory response and mediated by various cell types such as, bone-forming cells and immune cells, especially macrophages. The polarization of macrophages to inflammatory/regenerative (M1/M2) phenotypes, as well as the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) at the bone–implant interface, significantly affects implant osseointegration and even causes implant failure. Graphene oxide (GO) is a promising candidate for performing implant surface functionalization to modulate the interactions between implants and cells. Herein, we explored the effects of a GO coating on the osteogenic differentiation of BMSCs and the polarization of macrophages to enhance the application of GO surface modification in improving bone–implant integration. In the present study, a large particle sandblasting and acid etching (SLA) surface that is commonly used in clinical practice was selected as the control group, and GO was deposited on the SLA surface by the ultrasonic atomization spraying technique. The surface characteristics of these two groups, including the surface morphology, roughness, wettability, protein adsorption capacity and cell compatibility, were assessed. Then, the effects of GO surface modification on the osteogenic differentiation of BMSCs and the polarization of macrophages were evaluated. The results showed that the GO coating was successfully fabricated on the titanium substrates, which endowed the SLA surface with improved hydrophilicity and protein adsorption capacity and reduced roughness. Compared with the SLA surface, the GO-modified surface significantly enhanced the osteogenic differentiation of BMSCs and the M2-phenotype polarization of macrophages in vitro. This dual-regulatory role is of great significance in achieving rapid osseointegration as well as resolving the poor osseointegration associated with macrophage-related inflammation.

Dual roles of graphene oxide modification for enhancing osteogenic differentiation of BMSCs and M2-phenotype polarization of macrophages.

Bactericidal and Biocompatible Properties of Plasma Chemical Oxidized Titanium (TiOB®) with Antimicrobial Surface Functionalization

Coating of plasma chemical oxidized titanium (TiOB^®) with gentamicin-tannic acid (TiOB^® gta) has proven to be efficient in preventing bacterial colonization of implants. However, in times of increasing antibiotic resistance, the development of alternative antimicrobial functionalization strategies is of major interest. Therefore, the aim of the present study is to evaluate the antibacterial and biocompatible properties of TiOB^® functionalized with silver nanoparticles (TiOB^® SiOx Ag) and ionic zinc (TiOB^® Zn). Antibacterial efficiency was determined by agar diffusion and proliferation test on Staphylocuccus aureus. Cytocompatibility was analyzed by direct cultivation of MC3T3-E1 cells on top of the functionalized surfaces for 2 and 4 d. All functionalized surfaces showed significant bactericidal effects expressed by extended lag phases (TiOB^® gta for 5 h, TiOB^® SiOx Ag for 8 h, TiOB^® Zn for 10 h). While TiOB^® gta (positive control) and TiOB^® Zn remained bactericidal for 48 h, TiOB^® SiOx Ag was active for only 4 h. After direct cultivation for 4 d, viable MC3T3-E1 cells were found on all surfaces tested with the highest biocompatibility recorded for TiOB^® SiOx Ag. The present study revealed that functionalization of TiOB^® with ionic zinc shows bactericidal properties that are comparable to those of a gentamicin-containing coating.

Rapid nano-scale surface modification on micro-arc oxidation coated titanium by microwave-assisted hydrothermal process

Nano to submicron scaled surface possesses excellent biological affinity and several processes have been undertaken to develop titanium implant with specific surface chemical and phase composition and nano-scale features. A simple process was used to modify the nano topographies on a micro-arc-oxidation (MAO) surface which shortens the time for the conventional hydrothermal process (HT). Nano-scaled anatase precipitates on the MAO surface with different crystallinities and morphologies were regulated via microwave-assisted hydrothermal in pure water (MWDD) or in pH conditioned mediums containing calcium and phosphorus ions (MWCP, MWCP9, MWCP11). The surface morphologies and structures were investigated by SEM, XRD, FTIR, and TEM. Anatase crystals as nano-spikes along [001] direction were observed on the surface of the MWDD and MWCP groups. Increasing the pH of the conditioned medium leads the precipitate to lose its crystallinity; the surface of MWCP11 is covered with amorphous anatase which has a 3D nano-sheet architecture. The MW treated surfaces possess superior hydrophilicity can adsorb more proteins (fibronectin and bovine serum albumin), and the osteoblasts-like MG63 cells on these surfaces have higher spreading ratios than on the MAO and HT groups. The cell viabilities in the MW groups were significantly higher than in the MAO and HT groups on the 7th day (P < 0.05), although their cell viabilities were similar on the first day. MWCP and MWCP11 have higher alkaline phosphatase activity on days 7 and 14 compared to other groups (P < 0.05). The MW treatment produces different nanomorphologies on the MAO surface and retains the original micro/submicron pores and surface calcium and phosphorus contents, thus it is expected to promote osseointegration without compromising the bond strength.

Research Progress Regarding Interfacial Characteristics and the Strengthening Mechanisms of Titanium Alloy/Hydroxyapatite Composites

Titanium alloy/Hydroxyapatite (HA) composites have become a hot research topic in biomedical materials, while there are some challenges concerning bioactivity and mechanical properties such as low interface adhesion at the interface between metal and ceramic, complex interfacial reactions, and so on. Nevertheless, composites with reinforced phases can reach special properties that meet the requirements of biomedical materials due to the strong interfacial interactions between reinforcing phases (nano-carbon, partial oxides, and so on) and Titanium alloys or HA. This review summarizes the interface properties and mechanisms of Titanium alloy/HA composites, including interfacial bonding methods, strengthening and toughening mechanisms, and performance evaluation. On this basis, the interface characteristics and mechanisms of the Titaniumalloy/HA composites with enhanced phase are prospected. The results show that the interfacial bonding methods in the Titanium alloy/HA composites include chemical reactions and mechanical effects. The strengthening and toughening mechanisms contain grain refinement strengthening, second phase strengthening, solution strengthening, cracks and pulling out mechanisms, etc. This review provides a guidline for the fabrication of biocomposites with both mechanical properties and bioactivity.

Lanthanum-silicate-substituted apatite synthesized by fast mechanochemical method: Characterization of powders and biocoatings produced by micro-arc oxidation

Lanthanum-silicate substituted apatite with equal concentrations of the substituents in the range of 0.2-6.0 mol were produced by a fast method - mechanochemical synthesis. This method makes it possible to synthesize a nanosized single-phase product by activating reaction mixtures containing CaHPO₄, CaO, La(OH)₃ and SiO₂·H₂O for 25-30 min in AGO-2 and AGO-3 planetary mills. The structure of the apatites was investigated by the FTIR and XRD methods. It was found that the synthesized samples with substituent concentrations up to 2 mol are substituted oxy-hydroxyapatites, at higher concentrations, they are substituted oxyapatites. The mechanochemically synthesized apatite with a substituent concentration of 0.5 mol was used for depositing biocoatings on titanium substrates by the micro-arc oxidation method. The structure of the coatings is mainly amorphous. In vitro biological tests demonstrated high biocompatibility of the coatings and the absence of cytotoxic action on mesenchymal stem cells.

Bioactivity and osteointegration of hydroxyapatite-coated stainless steel and titanium wires used for intramedullary osteosynthesis

A lot of research was conducted on the use of various biomaterials in orthopedic surgery. Our study investigated the effects of nanostructured calcium–phosphate coating on metallic implants introduced into the bone marrow canal. Stainless steel or titanium 2-mm wires (groups 1 and 2, respectively), and hydroxyapatite-coated stainless steel or titanium wires of the same diameter (groups 3 and 4, respectively) were introduced into the tibial bone marrow canal of 20 dogs (each group = 5 dogs). Hydroxyapatite coating was deposited on the wires with the method of microarc oxidation. Light microscopy to study histological diaphyseal transverse sections, scanning electron microscopy to study the bone marrow area around the implant and an X-ray electron probe analyzer to study the content of calcium and phosphorus were used to investigate bioactivity and osteointegration after a four weeks period. Osteointegration was also assessed by measuring wires’ pull-off strength with a sensor dynamometer. Bone formation was observed round the wires in the bone marrow canal in all the groups. Its intensity depended upon the features of wire surfaces and implant materials. Maximum percentage volume of trabecular bone was present in the bone marrow canals of group 4 dogs that corresponded to a mean of 27.1 ± 0.14%, while it was only 6.7% in group 1. The coating in groups 3 and 4 provided better bioactivity and osteointegration. Hydroxyapatite-coated titanium wires showed the highest degree of bone formation around them and greater pull-off strength. Nanostructured hydroxyapatite coating of metallic wires induces an expressed bone formation and provides osteointegration. Hydroxyapatite-coated wires could be used along with external fixation for bone repair enhancement in diaphyseal fractures, management of osteogenesis imperfecta and correction of bone deformities in phosphate diabetes.

Enhanced growth and osteogenic differentiation of MC3T3-E1 cells on Ti6Al4V alloys modified with reduced graphene oxide

Graphene and its derivatives, including graphene oxide (GO) and reduced graphene oxide (rGO), have been considered as promising candidates in tissue regeneration.

Nanoscale Surface Modifications of Orthopaedic Implants: State of the Art and Perspectives

Background:

Orthopaedic implants such as the total hip or total knee replacement are examples of surgical interventions with postoperative success rates of over 90% at 10 years. Implant failure is associated with wear particles and pain that requires surgical revision. Improving the implant - bone surface interface is a key area for biomaterial research for future clinical applications. Current implants utilise mechanical, chemical or physical methods for surface modification.

Methods:

A review of all literature concerning the nanoscale surface modification of orthopaedic implant technology was conducted.

Results:

The techniques and fabrication methods of nanoscale surface modifications are discussed in detail, including benefits and potential pitfalls. Future directions for nanoscale surface technology are explored.

Conclusion:

Future understanding of the role of mechanical cues and protein adsorption will enable greater flexibility in surface control. The aim of this review is to investigate and summarise the current concepts and future directions for controlling the implant nanosurface to improve interactions.

Silencing tumor necrosis factor-alpha in vitro from small interfering RNA-decorated titanium nanotube array can facilitate osteogenic differentiation of mesenchymal stem cells

Titanium implants are known for their bone bonding ability. However, the osseointegration may be severely disturbed in the inflammation environment. In order to enhance osseointegration of the implant in an inflamed environment, the small interfering RNA (siRNA) targeting tumor necrosis factor alpha (TNF-α) was used to functionalize titanium surface for gene silencing. The chitosan–tripolyphosphate–hyaluronate complexes were used to formulate nanoparticles (NPs) with siRNA, which were adsorbed directly by the anodized titanium surface. The surface characterization was analyzed by scanning electron microscope, atomic force microscopy, as well as contact angle measurement. The fluorescence microscope was used to monitor the degradation of the layer. The coculture system was established with mesenchymal stem cells (MSCs) grown directly on functionalized titanium surface and RAW264.7 cells (preactivated by lipopolysaccharide) grown upside in a transwell chamber. The transfection and knockdown efficiency of TNF-α in RAW264.7 cells were determined by fluorescence microscope, quantitative polymerase chain reaction, and enzyme-linked immunosorbent assay. The cytoskeleton and osteogenic differentiation of MSCs were also analyzed. Regular vertical aligned nanotubes (~100 nm diameter and ~300 nm length) were generated after anodization of polished titanium. After loading with NPs, the nanotubes were filled and covered by a layer of amorphous particles. The surface topography changed and wettability decreased after covering with NPs. As expected, a burst degradation of the film was observed, which could provide sufficient NPs in the released supernatant and result in transfection and knockdown effects in RAW264.7 cells. The cytoskeleton arrangement of MSCs was elongated and the osteogenic differentiation was also significantly improved on NPs loading surface. In conclusion, the siRNA decorated titanium implant could simultaneously suppress inflammation and improve osteogenesis, which may be suitable for peri-implant bone formation under inflammatory conditions.

The shear strength of three-dimensional capillary-porous titanium coatings for intraosseous implants

A plasma spraying process for the deposition of three-dimensional capillary-porous titanium coatings using a wire has been developed. In this process, two additional dc arcs are discharged between plasmatron and both the wire and the substrate, resulting in additional activation of the substrate and the particles, particularly by increasing their temperature. The shear strength of the titanium coating with 46% porosity is 120.6 MPa. A new procedure for estimating the shear strength of porous coatings has been developed.

Surface characterization and corrosion behavior of calcium phosphate-base composite layer on titanium and its alloys via plasma electrolytic oxidation: A review paper

In recent years, calcium phosphate-base composites, such as hydroxyapatite (HA) and carbonate apatite (CA) have been considered desirable and biocompatible coating layers in clinical and biomedical applications such as implants because of the high resistance of the composites. This review focuses on the effects of voltage, time and electrolytes on a calcium phosphate-base composite layer in case of pure titanium and other biomedical grade titanium alloys via the plasma electrolytic oxidation (PEO) method. Remarkably, these parameters changed the structure, morphology, pH, thickness and crystallinity of the obtained coating for various engineering and biomedical applications. Hence, the structured layer caused improvement of the biocompatibility, corrosion resistance and assignment of extra benefits for Osseo integration. The fabricated layer with a thickness range of 10 to 20 μm was evaluated for physical, chemical, mechanical and tribological characteristics via XRD, FESEM, EDS, EIS and corrosion analysis respectively, to determine the effects of the applied parameters and various electrolytes on morphology and phase transition. Moreover, it was observed that during PEO, the concentration of calcium, phosphor and titanium shifts upward, which leads to an enhanced bioactivity by altering the thickness. The results confirm that the crystallinity, thickness and contents of composite layer can be changed by applying thermal treatments. The corrosion behavior was investigated via the potentiodynamic polarization test in a body-simulated environment. Here, the optimum corrosion resistance was obtained for the coating process condition at 500 V for 15 min in Ringer solution. This review has been summarized, aiming at the further development of PEO by producing more adequate titanium-base implants along with desired mechanical and biomedical features.

Calcium orthophosphate deposits: Preparation, properties and biomedical applications

Since various interactions among cells, surrounding tissues and implanted biomaterials always occur at their interfaces, the surface properties of potential implants appear to be of paramount importance for the clinical success. In view of the fact that a limited amount of materials appear to be tolerated by living organisms, a special discipline called surface engineering was developed to initiate the desirable changes to the exterior properties of various materials but still maintaining their useful bulk performances. In 1975, this approach resulted in the introduction of a special class of artificial bone grafts, composed of various mechanically stable (consequently, suitable for load bearing applications) implantable biomaterials and/or bio-devices covered by calcium orthophosphates (CaPO4) to both improve biocompatibility and provide an adequate bonding to the adjacent bones. Over 5000 publications on this topic were published since then. Therefore, a thorough analysis of the available literature has been performed and about 50 (this number is doubled, if all possible modifications are counted) deposition techniques of CaPO4 have been revealed, systematized and described. These CaPO4 deposits (coatings, films and layers) used to improve the surface properties of various types of artificial implants are the topic of this review.